- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.00 / $1,300.00 / $3,884.00
| Facility | | $391.00 | $1,300.00 | $3,884.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,273.53 / $7,401.56 / $10,812.45
| Facility | | $3,273.53 | $7,401.56 | $10,812.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $165.96 / $165.96
| Facility | | $40.00 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.31 / $1,923.00 / $2,425.00
| Facility | | $214.31 | $1,923.00 | $2,425.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $20.84 / $20.84 / $20.84
| Facility | AS | $20.84 | $20.84 | $20.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.00 / $543.00 / $1,506.00
| Facility | | $177.00 | $543.00 | $1,506.00 |